The Greater Cleveland Cancer Prevention Research Collaborating Center

Sue Flocke, PhDCase Western Reserve University

October 29, 2014

This presentation was supported by Cooperative Agreement Number 1U48DP001930 from the Centers for Disease Control and Prevention. The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Prevention Research Center for Healthy Neighborhoods (PRCHN)

• Funded as part of national PRC network in 2009

• Our Focus: Disadvantaged urban neighborhoods– Community nutrition and food access– Tobacco prevention & cessation– Supportive environments for healthy eating and active living– Place-based health surveillance

2

78 out of 202 census tracts in Cleveland

have greater than30% living in poverty and

> 25% without HS diploma.

Priority for CPCRN

Tobacco use is a significant burden

Cleveland 31.5%Ohio 22.4US 20.0

Specific Aims

1. Conduct a study to improve efficiency and effectiveness of tobacco cessation referrals. Implement and test closed loop E-referral to QuitLine.

2. Establish an evidence activation team and rapid PDSA cycles to inform and impact policy and practice.

3. Contribute to the overall impact and success of the national CPCRN initiatives through cross-center collaboration.

PRCHN-CPCRN Investigators & Partners

MetroHealthSeeholzerKaelber, ISOther IT and clinical staff

10 community clinics

Tobacco Research Working Group

PRC Flocke, PISmith, Proj. Coord.Seeholzer, Co-ITrapl, Co-IKoroukian, Co-I

National Jewish HealthQuit Line provider

Ohio Dept of Health

Network of Community Advisors

Patient characteristics of adults who saw a MetroHealth provider for primary care in past 2 years

Ask Advise Connect (AAC)

Approach very successful in safety-net settings.

Systematic – EHR driven

Engages medical assistant vs. clinician

Facilitates documentation and referral to QuitLine

Vidrine JI, Shete S, Li Y, et al. The ask-advise-connect approach for smokers in a safety net healthcare system: a group-randomized trial. Am J Prev Med. 2013;45(6):737–41.Vidrine JI, Shete S, Cao Y, et al. Ask-Advise-Connect A New Approach to Smoking Treatment Delivery in Health Care Settings. JAMA Intern Med. 2013;173(6):458–64.

Project Phases

Phase Products

Phase 1 Establish & test closed loop e-Referral protocol

• Guide for establishing linkage Epic – NJH• Revised protocol for AAC training• Training manual for referral specialist• Resource document for NE Ohio

Phase 2 Pilot test in 2 sites;Evaluate impact across 10 sites

• Manuscripts on outcomes - Implementation AAC - Quit Line data – appropriate referrals,

enrollment - Patient report data – helpful, respectful

Phase 3 Develop tools and strategy for dissemination (statewide)

• Learning Collaborative materials

Proposed Cross-Center Projects

• Implement and test AAC and eReferral across multiple settings.– Randomize and test additional features– Best partners are those with Epic and strong working

relationships with primary care networks

• Other areas of interest– Capacity building & use of existing data– Integrating farmers’ markets with FQHC systems – opportunity

with the new Food Insecurity Nutrition Program grants from USDA and food assistance incentive programs.

– Collaboration across HPV initiatives – systems level and population-based interventions.